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Hormone ‘Balancing’ Myths: What Women Really Need to Know · Meaningful Medicine with Novant Health

• 0:03
  Amanda (Host): Meaningful Medicine is a Novant Health Podcast bringing you
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  access to leading doctors who answer questions they wish you would ask.
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  From routine care to rare conditions, our physicians offer tips to navigate medical
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  decisions and build a healthier future.
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  I'm Amanda Wild, and I am joined by obstetrician and gynecologist, Dr.
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  Christie Cook.
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  We'll delve into the truth about hormones, what misinformation you
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  should be wary of, and how to make educated decisions for your health.
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  Dr.
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  Cook, welcome and thank you so much for being here to share your expertise.
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  Christi Cook, MD: Thank you for having me.
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  Amanda (Host): Well, first of all, we're hearing the phrase hormone
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  balancing everywhere these days.
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  What does that even mean from a medical perspective?
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  Christi Cook, MD: Well, primarily what it means is that we're sort
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  of replacing hormones that our body used to make naturally.
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  And now the average age of menopause is 51, which means
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  that's a year without a period.
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  But women clearly start experiencing symptoms well before that.
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  Women can also go through menopause naturally, even in their forties, so their
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  symptoms can even start in their thirties.
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  So basically balancing or replacing hormones is basically
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  just replacing the hormones that our bodies used to make naturally.
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  Amanda (Host): So Dr.
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  Cook, what are these online options and these pop-up hormone shops?
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  That's rather new, isn't it?
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  Christi Cook, MD: It is, and I mean, social media has done a great job
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  with, bringing hormone treatments and women's health to the forefront.
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  But also now we are having these for-profit hormone clinics
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  and online options for women, which can be good in ways.
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  But I do feel like women need to be somewhat.
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  Weary and skeptical as well because they are for-profit companies.
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  So I strongly encourage women if they are starting to have symptoms,
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  something doesn't feel right.
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  They're starting to notice some changes, like changes in their periods, hot
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  flashes, night sweats, changes in mood.
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  Vaginal dryness, they're having issues with intercourse with
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  their partners and so on.
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  There's an array of things that can be related to their hormones.
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  But I strongly encourage women to seek treatment from their healthcare providers,
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  gynecologists their primary care that kind of thing because there are certainly
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  disease processes and things that can mimic symptoms of the perimenopause and
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  menopause.
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  And those things need to be thoroughly evaluated, which you
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  can't do online before any type of treatment is prescribed.
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  Also, most of the time I'm able to evaluate, get appropriate
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  lab testing and treat and build that through women's insurance.
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  We pay a lot of money every month for our healthcare insurance,
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  and we should be able to use it.
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  Perimenopause and menopause are considered medical conditions,
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  but all of us women, if we live long enough, will experience this.
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  So we should seek care but we should be able to have a lot of this build
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  through our insurance company to allow access for all women to get help.
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  Amanda (Host): So see the professionals, but of course social media is everywhere.
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  What are the most common myths you're seeing either on social media, online
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  or in these popup hormone shops?
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  Christi Cook, MD: Well, a lot of myths are if a woman is having,
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  maybe some mood changes, maybe a little bit of weight gain.
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  It isn't always hormones, right?
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  It isn't always perimenopause and menopause, and women could have,
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  changes in their periods, which could be a sign of a more serious problem.
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  So I strongly encourage women again to.
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  See their gynecologist or other providers to have these things evaluated.
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  Not everything should be treated with hormones and not everything
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  requires treatment with hormones.
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  So that's, I think, the biggest takeaway is, yes, it is extremely common, but there
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  could be something a lot more serious going on that should be evaluated as well.
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  Also, you know, meds are, you don't have to go to one of these
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  pop-up hormone clinics to get treatment again, gynecologists.
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  Other providers are very skilled in treating perimenopause and menopause,
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  and again, should be able to be billed through your insurance.
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  We should be able to get most medications through your standard pharmacy.
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  We don't have to have things compounded, which are.
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  Not FDA approved and can be very expensive.
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  I oftentimes have women come into my office, they have spent thousands
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  and thousands of dollars trying to get help and, that really could
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  have been avoided had they started with their primary care or their
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  gynecologist or their other providers.
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  Amanda (Host): So what you're saying is what we see online can be very
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  misleading, cost you financially, and there's no one size fits all.
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  So when might a woman truly benefit from evaluation or therapy and talk
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  about what a safe evidence-based process really looks like.
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  Christi Cook, MD: Well, certainly if women are starting to notice changes
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  in their period that are bothersome or worrisome, certainly if they are
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  starting to have, classic symptoms of menopause, hot flashes, night
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  sweats, mood changes, vaginal dryness, recurrent vaginal infections painful
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  sex, weight changes, any of those things that are really starting to.
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  Affect daily life, then they really need to seek treatment.
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  And you're right, it is a very individualized approach.
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  Certainly we should make sure that women are up to date on their screening exams.
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  We certainly need to perhaps rule out other causes of their symptoms that aren't
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  related to perimenopause or menopause.
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  So that sometimes definitely involves some labs.
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  People always ask about, do I need my hormones checked?
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  Sometimes it is helpful, sometimes it may not be.
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  And that all depends on that particular person's circumstance.
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  Then, conversation needs to take place.
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  Certainly medications have risks associated with them, but we do
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  know that hormone replacement offers so many benefits.
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  So we definitely need to have that conversation and it needs
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  to be individualized approach as to how we manage that.
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  Most of the time, again, we can prescribe medications that
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  are FDA approved and very safe.
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  At your standard pharmacies to avoid some of these really high out of
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  pocket expenses, but it does need to be an individualized approach.
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  There is no one size fits all certainly in this circumstance.
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  Amanda (Host): Well, many businesses do market themselves
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  as natural or personalized.
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  What should patients know about FDA oversight and compounding and safety.
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  Christi Cook, MD: Well, certainly a lot of the buzzwords that you hear
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  are like bioidentical hormones.
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  Well, bioidentical hormones are available at your pharmacy, but women don't always
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  know that anything that is compounded, however, is not going to be FDA approved.
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  So we run into issues potentially with safety.
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  If they're not regulated, we could run into dosing issues.
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  We could certainly run into issues with contamination in some of
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  these compounding pharmacies.
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  So we certainly have to be.
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  Careful when we're taking compounding medications.
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  It's not to say that we don't always use them because we certainly do.
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  But again, it's a very individualized approach.
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  But bioidentical medications like estrogen and progesterone are
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  available at standard pharmacies.
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  Amanda (Host): What risks come with taking hormones without the proper testing
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  or diagnosis or medical supervision?
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  Christi Cook, MD: Well, certainly there are contraindications
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  to being on hormone therapy.
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  Most people, know about estrogen and, progesterone receptor
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  positive breast cancers.
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  Certainly that is an absolute contraindication to systemic hormones,
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  but now not vaginal, estrogen.
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  So we need to make sure that women are up to date on their screening for their
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  mammograms, that they've had a recent breast exam and those kind of things.
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  Certainly again, that conversation going through the patient's past
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  medical history and things, making sure that they've never had a stroke,
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  they've never had a blood clot.
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  Which also can be contraindications to being on hormones.
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  Now, that's not to say if they do have those contraindications,
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  that other treatment options aren't available because they are.
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  And again, that's why it's so important to sit down with the appropriate
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  providers so they can go through all of the alternatives as well.
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  We do know that hormone replacement does offer so many benefits.
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  Benefits, of course, that we, can feel pretty quickly like with
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  our hot flashes and night sweats and mood and things like that.
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  But there's so many things for prevention that is so important as well, helping to
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  prevent cardiovascular disease if taken early enough in the transition period.
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  Prevention of significant bone loss, possibly even reduction in dementia.
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  Certainly we see reduction in colon cancer risks, so there is just a lot of benefits,
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  but again, it needs to be discussed.
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  Each person is different, their histories different, their
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  medications are different, their family histories are different, and
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  that's why it is so important that.
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  Every woman sits down with the appropriate provider and they go
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  through this on a case by case
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  Amanda (Host): And we really do have to be monitored.
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  Sometimes we can get symptoms like fatigue or weight gain or mood
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  changes that are blamed on hormones.
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  But you were saying earlier, other factors could be involved.
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  What could that be?
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  Christi Cook, MD: certainly a lot of disease processes that can
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  mimic the symptoms of menopause.
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  could be cardiovascular disease, which causes significant fatigue,
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  could be diabetes, could be thyroid issues, could be adrenal issues.
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  I mean, There's a vast array of disease processes that can cause
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  very similar symptoms to menopause.
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  So that's where again, a thorough evaluation comes in.
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  Appropriate lab testing comes in so that we are not treating women inappropriately.
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  Amanda (Host): How can women advocate for themselves to find trusted
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  qualified providers when we are facing confusing or conflicting hormone advice?
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  Christi Cook, MD: Well, I certainly encourage women to go back to the
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  physicians providers that they have had a relationship with for a while.
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  Perhaps their ob, GYN, that delivered their babies are typically very, very
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  skilled in treating the menopause.
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  Certainly.
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  Physicians like myself that only now treat gynecological patients is
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  certainly an avenue to go down as well.
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  Some of us do have extra training in menopause.
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  I'm a certified menopause clinician through the Menopause Society, and there
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  are a lot of providers out there that, that is sort of their area of expertise.
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  Women can go to the Menopause Society website and they can type in
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  their zip codes or their town that they live in across the country.
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  And those specialized providers are available on that website.
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  Amanda (Host): That is really great information.
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  Lastly, Dr.
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  Cook, what do you wish every woman's scrolling social health
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  media advice would keep in mind?
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  Christi Cook, MD: Well, like I said, I mean, social media
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  has really helped our cause.
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  However, you never wanna get your medical advice from anecdotal experience
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  on the internet or on Facebook or group chats or those kind of things.
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  Certainly it's good that, we get validation by hearing other women
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  that are going through those same things that we're going through.
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  And perhaps they've gotten wonderful treatment and they're
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  feeling better, but again, their treatment may not be your treatment.
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  So I would certainly encourage you to seek appropriate help like we've discussed and
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  try to avoid falling into pitfalls and going to, clinics that are gonna cost.
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  Thousands and thousands of dollars when that could be avoided if
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  they just turn to their trusted
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  Amanda (Host): So when we're looking at social media and other source.
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  Is, it's important to keep in mind that is general and when it's time
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  for you personally to get treatment.
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  It's really important to go to your medical professionals and get the
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  appropriate testing and monitoring,
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  Christi Cook, MD: And, just like any other physician, I mean, if you're not
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  happy with the one that you originally chose, then seek other advice.
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  There's nothing wrong with seeking a second opinion and eventually
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  you'll find the right fit.
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  Amanda (Host): So you're in charge.
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  You're in the
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  driver's seat
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  Christi Cook, MD: Yes.
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  Amanda (Host): Such helpful information.
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  Dr.
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  Christie Cook, thank you so much for providing clarity on
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  hormones and hormone therapy.
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  Appreciate that.
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  Christi Cook, MD: Thank you.
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  Amanda (Host): To find a physician, visit novant health.org.
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  For more health and wellness information from our experts,
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  visit healthy headlines.org.
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  This is Meaningful Medicine, a Novant Health podcast.